Many adenomas possess a capsule

Many adenomas possess a capsule and can be separated from a surrounding tissue. Some surgeons consider, that application for some seconds of alcohol on a box of a tumour after its excision promotes destruction of all remained tumoral cells. In appreciable number of cases, however, especially at the tumours which sizes exceed 10 mm, the tumour is indistinctly delimited from a surrounding tissue, contains necrotic buy maxalt or hemorrhagic sites or has the cystic nature. The cyst can be informed with a subarachnoid space and frame a picture of partially "empty" Turkish saddle. In such cases probability of normalisation of level of Prolactinum much less, and some surgeons recommend at these tumours . Owing to different structure of groups of patients and, that is more probable, differences in a technique of an operative measure efficiency of the surgical help estimated on normalisation of level of Prolactinum and spontaneous restoration of a menses, widely varies. It is standard, that the highest results turn out at smaller tumours (with the sizes less than 10 mm or at Prolactinum level before operation less than 200 ng/ml) [126, 127, 216]. At such patients efficiency of a surgical intervention is reached 94 [127], though in most cases by it nevertheless a little bit more low. At larger tumours results are less favorable; though depression of level of Prolactinum is observed usually in 70-80 of cases, it is normalised only at 20-30 of patients. Quite often even at it would seem a full oncotomy Prolactinum level remains raised. It is bound to incompleteness of an oncotomy or its multicentric growth, a hyperplasia of a surrounding tissue or the changed blood supply normal , it is difficult to define without long observations.
At small adenomas even at conservation postoperative an irradiation after operation usually do not recommend; it use only at the tumours which are finding out signs of invasive growth or not giving in to full excision. Radial therapy Primary treatment tumours by means of an external irradiation is applied less often, than surgical and consequently there are only limited data on its influence on secretion of Prolactinum [191]. Nevertheless Prolactinum level in such cases decreases, apparently, more slowly and to a lesser degree, than after operation. A roentgenotherapy (with the subsequent ) instead of operation recommend to spend the patient with and the minimum radiological changes of a Turkish saddle which wish to become pregnant [217]. As the basis for such treatment the risk of growth of a tumour during pregnancy at women with clinical signs adenomas which did not receive previous treatment serves. However definitively to estimate efficiency of such approach, are necessary long observations. Pharmacotherapy Big stride forward in treatment was application 2-a-bromergokriptina () - derivative alkaloids of the ergot, an agonist of Dofaminum possessing powerful activity in the relation receptors of a brain and a pituitary body [183]. Experience of use of this substance, saved up for last 7 years, testifies to its efficiency in respect of depression of level of Prolactinum approximately on 80-90 almost at all patients with irrespective of its aetiology. Full normalisation of the maintenance of Prolactinum is most probable besides at patients with its initial level less than 200 ng/ml. operates immediately on , that it is possible to see in vitro [84, 219] though it is impossible to exclude and its secondary action on . The effect orlistat xenical is characterised by quick start (in some hours) and small duration so preparation cancellation leads to restoration . In many cases, even at conservation some the raised level of Prolactinum, decreases or the galactorrhea disappears. Like it restoration of recurrence of a menses and a fecundity can occur and without full normalisation of level of Prolactinum. The dose of a preparation of 2,5 7,5 mg/sut, prescribed fractionally is necessary for the majority of patients. Treatment begin with the least dose which gradually enlarge before reception of the necessary effect. In some cases it is necessary to apply 15 mg/days To by-effects the nausea and vomiting owing to a boring of the vomitive centre and sometimes a hypotension also owing to influence on the central mechanisms of regulation of arterial pressure concern mainly. At some patients it interferes with preparation application. It is necessary to select its dose carefully. By time of a writing of the present book the commission on alimentary and medicinal substances of the USA has approved application only in case of a syndrome of an amenorrhea-galactorrhea in the absence of a tumour of a pituitary body during the limited term (6 ) and not as an agent raising a fecundity. However the majority of the patients accepting this preparation, intend to become pregnant.